Surgical treatment of fibroids for subfertility

Griffiths AN, D'Angelo A, Amso NN

Published Online:

November 10, 2010

Fibroids are benign tumours located in the uterus (womb) which are associated with infertility. Fertility preserving treatments for fibroids include myomectomy (surgical removal of the fibroid) but this has a significant risk of potential hysterectomy (surgical removal of the womb). Fibroids can be removed via laparotomy (traditional open operation to access the abdominal cavity), laparoscopy (key hole surgery to access the abdominal cavity) or hysteroscopy (viewing the uterine cavity via the cervix with the aid of a telescopic instrument). The review assesses the differing surgical methods for treating fibroids with regard to improving fertility outcomes with minimal side effects. Twenty three studies were identified but only one study with 131 women was a randomised controlled trial. There was no difference in the fertility outcome between women who had fibroids removed by laparotomy compared to laparoscopy. There were some non-fertility benefits noted by removal of fibroids by laparoscopy compared to laparotomy.

Abstract (click to read)

Background:

Fibroids are benign tumours of the uterus occurring in up to 77% of women. Fibroids have been noted to occur more frequently in women with infertility. Retrospective studies have suggested the benefit of surgically removing fibroids to increase the fertility efficacy of both natural conception and assisted conception. There are a variety of methods to surgically remove fibroids including laparotomy, laparoscopy and hysteroscopy. The relative advantages and disadvantages of these modalities in terms of fertility efficacy and side effects are unknown.

Objectives:

To determine the efficacy and safety of the removal of uterine fibroids in subfertile women by laparotomy, laparoscopy or hysteroscopy when compared with expectant management or each other. The review will include also new surgical approaches as and when they are trialed.

Search strategy:

We searched the Cochrane Menstrual Disorders and Subfertility Review Group Specialised register of controlled trials, MEDLINE (PUBMED) 1985 to 2004, EMBASE (1985 to 2004), CINAHL (1985 to 2004) and National Research Register.

Selection criteria:

Randomised controlled trials (RCTs) in which fibroids were removed via surgery for the treatment of infertility

Data collection and analysis:

Three authors independently assessed trial quality and extracted data.

Main results:

Only one randomized controlled study was included (131 women) and this was probably underpowered. There was no evidence of a difference in outcome in terms of clinical pregnancy rate and live birth rate when fibroids were removed via laparotomy or laparoscopy for infertility. There were some non fertility benefits of removal via laparoscopy including shorter hospital stay, less febrile illness and a smaller drop in pre-operative haemoglobin concentration when compared to laparotomy.
There were no randomised controlled studies comparing hysteroscopic removal or no intervention with other surgical modalities.

Authors' conclusions:

There is limited evidence to suggest that there is no difference in fertility efficacy outcome if fibroids are removed via laparotomy when compared to laparoscopy. There is no good randomised controlled evidence to support hysteroscopic removal of fibroids compared to other surgical modalities for fertility efficacy.

This record should be cited as:

Griffiths AN, D'Angelo A, Amso NN. Surgical treatment of fibroids for subfertility. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD003857. DOI: 10.1002/14651858.CD003857.pub2

Assessed as up to date:

May 15, 2006

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Primary Review Group:

Menstrual Disorders and Subfertility Group

Health topics:

Gynaecology > Subfertility > Female: associated with other medical conditions

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Surgical treatment of fibroids for subfertility

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